Successful Generation of CD19 Chimeric Antigen Receptor T Cells from Patients with Advanced Systemic Lupus Erythematosus

Although it has been shown that the production of functional chimeric antigen receptor T cells is feasible in patients with B-cell malignancies, it is currently unclear whether sufficient amounts of functional autologous CAR T cells can be generated from patients with autoimmune diseases. Intrinsic T-cell abnormalities and T-cell-targeted immune suppression in patients with autoimmunity may hamper the retrieval of sufficient T cells and their transduction and expansion into CAR T cells. Patients with active systemic lupus erythematosus (SLE) underwent leukapheresis after tapering glucocorticoids and stopping T-cell-suppressive drugs. This material was used as source for manufacturing anti-CD19 CAR T-cell products (CAR) in clinical scale. Cells were transduced with a lentiviral anti-CD19 CAR vector and expanded under good manufacturing practice (GMP) conditions using a closed, semi-automatic system. Functionality of these CAR T cells derived from autoimmune patient cells was tested in vitro. Six SLE patients were analyzed. Leukapheresis could be successfully performed in all patients yielding sufficient T-cell numbers for clinical scale CAR T-cell production. In addition, CAR T cells showed high expansion rates and viability, leading to CAR T cells in sufficient doses and quality for clinical use. CAR T cells from all patients showed specific cytotoxicity against CD19+ cell lines in vitro. GMP grade generation of CD19 CAR T-cell products suitable for clinical use is feasible in patients with autoimmune disease.

A case report of successful eradication of new isolates of Burkholderia cenocepacia in a child with cystic fibrosis

Chronic respiratory infection with Burkholderia cenocepacia (Bc) in patients with cystic fibrosis (CF) is associated with accelerated decline in lung function and increased mortality. It is therefore important to attempt to eradicate new isolates, especially in children. However, there are no standardized guidelines to eradicate Bc. We report a case of successful eradication of new isolates of Bc in a 2-year-old child with CF using a combination of IV, nebulized antibiotics and sinus surgery.

[The motivational week: A new approach in smoking cessation]

INTRODUCTION

Smoking cessation is complex and challenging. The motivational week is a multidisciplinary approach that has been established in order to increase the chances of quitting smoking. The purpose of this study was to determine the rates of abstinence achieved and the predictive factors for quitting.

METHODS

Clinical data, smoking status, levels of dependence and motivation as well as rates of continuous abstinence in the short and long-term of all patients who participated in the motivational week were analysed.

RESULTS

Two hundred and thirteen patients were included. The mean age was 49.8 years (10.6). The rates of continuous abstinence were 40.4% at 6 months, 29.1% at 12 months and 21.6% at 2 years. Using logistic regression, having depression or a history of depression was associated with reduced likelihood of smoking cessation: OR: 0.32 [95%CI: 0.16-0.76; P=0.003] at 6 months, OR: 0.35 [95%CI: 0.16-0.77; P=0.009] at 12 months and OR: 0.27 [95%CI: 0.11-0.65; P=0.004] at 2 years.

CONCLUSIONS

The motivational week seems to be an approach which is effective long-term and could be used in smoking cessation. This study confirms that depression is an unfavourable factor for quitting.

The clinical benefits of long-term supplementation with omega-3 fatty acids in cystic fibrosis patients - A pilot study

Effectiveness of omega-3 supplementation in cystic fibrosis (CF) remains controversial. This study sought to evaluate clinical status, exercise tolerance, inflammatory parameters, and erythrocyte fatty acid profile after 1 year of oral omega-3 supplementation in CF patients. Fifteen ΔF508-homozygous patients undergoing chronic azithromycin were randomized to receive omega-3 fish oil supplementation at a dose of 60mg/Kg/day or placebo. In comparison with the previous year, in the supplemented group, the number of pulmonary exacerbations decreased at 12 months (1.7 vs. 3.0, p<0.01), as did the duration of antibiotic therapy (26.5 days vs. 60.0 days, p<0.025). Supplementation significantly increased the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as early as <3 months of administration, with concomitant decreases in arachidonic acid (AA) levels. This pilot study suggests that long-term omega-3 supplementation offers several clinical benefits as to the number of exacerbations and duration of antibiotic therapy in CF patients.

[Management of tobacco smoking in general practice]

Tobacco is a hard drug causing triple dependence. The medical management of tobacco smokers is thus complex and challenging. It requires a global approach combining non-pharmacological and pharmacological treatment. The general practitioner, having a privileged status, plays an important role. The recommended management is the strategy of the 5As (Ask, Advice, Assess, Assist, Arrange). This article proposes the management of tobacco smoking and cessation, in general practice, in the adult smoker, as well as the specificities of tobacco smoking and cessation in the pregnant woman and the teenager.

Clinical aspects of chronic ENT inflammation in children

In children, all ENT cavities are particularly prone to the development of chronic inflammation. This is due to many predisposing factors, of which the most common are unfavourable anatomy, absence of nasal blowing, day care attendance, allergy, immature immunity, gastro-oesophageal reflux and tobacco smoke exposure. The aim of this paper is to outline the most specific paediatric clinical aspects of chronic pharyngo-tonsillitis, rhinosinusitis, otitis media, adenoiditis and laryngotracheitis and the important influence that some of these pathologies exert on the others.

[Acute respiratory dyspnea in children]

Acute respiratory dyspnea is very frequent in children and must be quickly treated to obtain the best prognosis. The diagnosis depends from the natural history of the disease and from the quality of clinical assessment. The use of an algorithm according to the presence of stridor or bronchospasm is very contributive to the diagnosis. The paper reviews the pathophysiology of dyspnea in children and the more common diseases that are causing respiratory distress. Finally, treatment of respiratory failure and management of specific diseases are defined.

[Immunoallergology in children: diagnosis and treatment]

Atopy is the most frequent allergic disease in western countries: about 30% of children are suffering from various forms of its manifestations. During the 20th century, its frequency gradually increased. This is not only true for sensitization (presence of specific immunoglobulin E (IgE) in the skin or in the serum), but also for clinical symptoms associated with sensitization. It is usually a disease of skin and mucosae, but atopy can also become systemic (anaphylaxis). Hygienist hypothesis (reduction of infectious diseases and Th1 pressure) gives a possible explanation to the impressive increase of allergic diseases during the last decades. In the child, atopic dermatitis and food allergies are first observed (allergic march): 5 allergens explain more than 85% of cases (white egg, milk, peanuts, fish and nuts). Skin prick tests are more sensible than specific IgE measurements in the serum; they are usually done before. Provocation tests (labial and oral) can confirm the diagnosis when necessary. Four families of aeroallergens are described (pollens, house dust mites, pets and moistures). Eviction is the first line of treatment, than drugs are prescribed to reduce symptoms and inflammation (corticosteroids, antihistamine). Desensitization and immunomodulators that can induce tolerance are also proposed in defined situations.

[Brain in the core of metabolic regulations: disorders in schizophrenic patients treated with atypical antipsychotics]

Schizophrenia is associated with an increased risk of metabolic disorders such as diabetes, dyslipidaemia and the metabolic syndrome. The prevalence of type 2 diabetes in schizophrenic patients is at least twice that of the general population. Around 40 percent of patients meet criteria for the metabolic syndrome. Recently there is a growing concern on the metabolic side effects of treatment with second generation antipsychotics. According to various studies, including a prospective study performed in Flanders, treatment with clozapine and olanzapine has the highest metabolic risk, followed by quetiapine and risperidone. Amisulpride, ziprasidone and aripiprazole appear to have a low metabolic risk. Appropriate care, taking into account the possible improvement of the metabolic risks factors, is important to reduce morbidity and mortality in schizophrenic patients treated with antipsychotic medications.

Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study

Background

Patients with schizophrenia are at high risk of developing metabolic abnormalities.

Method

A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an oral glucose tolerance test, is currently ongoing at our University Hospital and affiliate services. The prevalence of metabolic abnormalities at baseline was assessed in a cohort of 415 patients with schizophrenia. The sample was divided into 4 groups according to duration of illness: first-episode patients (<1.5 years), recent-onset patients (between 1.5 and 10 years), subchronic patients (between 10 and 20 years) and chronic patients (>20 years).

Results

Metabolic abnormalities were already present in first-episode patients, and considerably increased with increasing duration of illness. When compared to the general population matched for age and gender, much higher rates of the metabolic syndrome (MetS) and diabetes were observed for patients with schizophrenia. For MetS, the increase over time was similar to that of the general population. In contrast, the difference in the prevalence of diabetes in patients with schizophrenia and the general population dramatically and linearly increased from 1.6% in the 15–25 age-band to 19.2% in the 55–65 age-band.

Conclusion

Thus, the current data suggest that on the one hand metabolic abnormalities are an inherent part of schizophrenic illness, as they are already present in first-episode patients. On the other hand, however, our results suggest a direct effect of the illness and/or antipsychotic medication on their occurence. The data underscore the need for screening for metabolic abnormalities in patients diagnosed with schizophrenia, already starting from the onset of the illness.

Pharmacological treatment of ambulatory schizophrenic patients in Belgium

Background

the objective of this study was twofold:

1) Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium.

2) Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines.

Method

A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected.

Results

In Belgium, the use of atypical antipsychotics is frequent (69%) in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8%) or second-generation, atypical antipsychotics (53.2%). 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs.

Conclusion

Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

[Neuroleptic drug utilization among schizophrenic outpatients]

BACKGROUND

Our objective was to describe and compare neuroleptic drug utilization patterns among French schizophrenic outpatients in public and private care settings.

METHODS

A cross sectional survey was carried out by a random sample of 61 public and 112 private psychiatrists who registered for one month all schizophrenic adult outpatients treated with a neuroleptic drug. Among registered patients, each psychiatrist was to include a maximum of 18 patients (public setting) or 9 patients (private setting). Statistical analysis was weighted to take into account for psychiatrist activity level, assessed by patient registration.

RESULTS

Psychiatrists included 934 patients in the public care setting and 927 patients in the private care setting. Patients were (mean+/-sd) 40.1+/-12.1 years old, 60.9% men. The patients' social and clinical characteristics were less favorable in the public setting than in the private setting: no professional activity (78.9% vs 65.1%), living in institution (7.2% vs 3.7%), under legal protection (35.1% vs 14.5%), drug abuse (9.6% vs 5.6%). An atypical neuroleptic was prescribed for 63.0% of patients and a classic neuroleptic for 49.7%, an association of neuroleptics for 22.0%. In both settings, the most prescribed neuroleptics were olanzapine (28.0%) and risperidone (18.6%) with a higher mean daily dosage in the public care setting. At least one neuroleptic treatment change (drug and/or dosage) occurred during the previous year for 44.9% and 39.2% patients, in public and private settings, respectively. In both settings, reasons for changes were mainly lack of efficacy (55.1%) and side effects (49.8%).

CONCLUSION

Public and private care populations were different but not as much as expected. In both settings, atypical neuroleptics were the predominant drugs used in the treatment of schizophrenia outpatients. The high frequency of drug change for lack of efficacy or side effects demonstrates the difficulties with the use of the present neuroleptic armamentarium.

[Child food allergy: results of a Belgian cohort]

INTRODUCTION

Food Allergy is a public health problem because of its increasingly prevalence, its severity and the difficulty of diagnosis.

OBJECTIVE

to describe the responsible food allergens and the clinical features of food allergy in a large group of Belgian children.

METHOD

156 cases of food allergy observed between May 2002 and May 2005 were retrospectively reviewed. All patients have specific IgE. Unequivocal history, response to elimination diet, labial or oral food challenge confirmed the diagnostic.

RESULTS

Median age is 26 months (range 1 months-14 years) and male to female ratio is 1.6. Fifty-nine percent of the cases are younger than 3 years. Family history of atopic disease is found in 80.3%. Foods most commonly involved are: eggs (31%), tree nuts (18.1% including hazelnuts 12.3%), cow's milk (16.1%), peanuts (13.2%), fish (4.5%), latex fruits (4.5%).The clinical manifestations are: atopic dermatitis (44.2%), urticaria (40.4%), angioedema (36.5%), gastrointestinal symptoms (21.8%), laryngeal edema (11.5%), asthma (9%), oral allergy syndrome (7.7%), systemic reactions (7.7%) and anaphylactic shock (3.8%). Multiple food allergies are rare: 78.9% of our population have one or two food allergies.

CONCLUSION

This study confirms the usual distribution of food allergens in children. It shows that only four allergens (egg, tree nut, cow's milk, peanut) are responsible for 78.4% of the reactions and highlights the emergence of tree nuts allergy, particularly hazelnuts, in Belgium.

Relevance of bone mineral density, bone quality and falls in reduction of vertebral and non-vertebral fractures

All epidemiological studies conclude that without prompt, concerted and well-designed prevention programs, the increasing cost related to osteoporotic fractures will become an unbearable burden for the community within the next fifteen years. However, the most effective way of setting up such preventive strategies is not yet unequivocally defined. Low bone mass and microarchitectural damage of bone tissue may account for a large part of the epidemiology of vertebral fractures. Extraskeletal determinants, including low muscle strength, poor balance and gait, all resulting in an increased propensity to fall, also play a major role in the occurrence of hip fracture. Depending on the localization of the fractures, the relative importance of skeletal and extraskeletal risk factors can significantly differ. For prevention of vertebral fractures, drugs affecting bone mass and skeletal architecture may provide a substantial benefit while hip fracture prevention will be more successfully targeted by multi-faceted strategies concentrating not only on the skeletal dimension of the fracture but also aiming, either pharmacologically or through multi-intervention programs, at a reduction in the incidence and in the consequences of falls in the elderly.

[Prevention of frailty in the elderly: a demographic challenge]

World population is ageing. This phenomenon is unprecedented, universal, long-lasting and has important implications. Unprecedented, because never before in human history, so many individuals have reached an advanced age. Universal, because all countries are now concerned. Long-lasting, because ageing started in the second half of the XXth century and will become even more pronounced over the XXIst century. With important implications, because it has and will have substantial consequences on human life and social composition. This article reviews quantitative data on ageing to appraise its extent and implication, the goal being to extend and stimulate the debate on ageing. International data are first presented, then analysis moves to Belgium estimates.

Types of respiratory activity in Moniliella tomentosa during growth under different conditions

The osmophilic yeastlike fungus Moniliella tomentosa is an obligate aerobe and is not susceptible to glucose repression. Respiration is greatest in exponentially growing cells and is then highly sensitive to cyanide. Respiration in older cells or in chloramphenicol-grown cells is mediated by a cyanide-insensitive respiration which is sensitive to salicyl hydroxamic acid. Growth of cells under reduced oxygen does not influence the respiratory capacity of the cells but results in a longer generation time and a lower final cell yield. Low aeration levels and growth in the presence of chloramphenicol have a profound effect on ethanol and polyol production.

Adenosine 5'-monophosphate-stimulated cyanide-insensitive respiration in mitochondria of Moniliella tomentosa

Mitochondria of the yeastlike fungus Moniliella tomentosa oxidize reduced nicotinamide adenine dinucleotide, reduced nicotinamide adenine dinucleotide phosphate, succinate, isocitrate, and lactate. These oxidations are completely inhibited by cyanide or antimycin A in mitochondria isolated from cells grown in the standard medium. On the other hand, the oxidation of all substrates, except lactate, is almost completely insensitive to cyanide or antimycin A in mitochondria from cells grown in the presence of ethidium bromide. In this instance, the oxidation is mainly mediated by an alternate oxidase which can be blocked by salicyl hydroxamic acid. The alternate oxidase can be specifically stimulated by adenosine 5'-monophosphate and this provides a new method for the characterization of the alternate oxidase in mitochondria of M. tomentosa.

Isolation and identification of phenolic substances from the fungus Penicillium spinulosum

Penicillium spinulosum grown in a Czapek-Dox medium containing glucose produces two phenolic substances: 4-methyl orcinol (beta-orcinol) and 3-methyl orsellinic acid (beta-orcinolcarboxylic acid). Their isolation and identification are described. They are considered to be precursors of quinoids occuring in aged media and responsible for their red-violet colours. Preliminary results indicate that one of the quinoid compounds may be a diphenoquinone.

pH-dependent polyol production in Moniliella tomentosa

Production of polyols by the yeastlike fungus Moniliella tomentosa could be increased by growing the organism at constant low pH. Up to 54% increase in yield was obtained. Growth at low pH also results in the production of D-arabitol which is not found in normal media.